Signs, Symptoms, and Complications of Sleep Apnea
- Excessive daytime sleepiness (EDS) and impaired alertness
- Increased risk of driving and work-related accidents
- Moodiness, belligerence, and decreased attentiveness and energy
- Higher risk of diabetes
- Lack of awareness or misdiagnosis due to varied symptoms
- Daytime fatigue, sleepiness, cardiovascular problems, and eye problems
- Increased risk of severe complications of COVID-19
- Higher risk of developing other medical conditions
- Sleep-disordered breathing is associated with an increased risk of cardiovascular disease, stroke, and high blood pressure
- Daytime functioning problems include sleepiness, motor vehicle crashes, and decreased cognitive functioning
- Psychological problems and reduced quality of life are also associated with sleep apnea
- Stroke and cerebrovascular diseases are linked to obstructive sleep apnea
- Sleep apnea can contribute to hypertension that persists during sleep
Mechanism of Sleep Apnea
- Build-up of carbon dioxide in the bloodstream triggers awakening and clears the airway
- Decreased output of the brainstem regulating chest wall or pharyngeal muscles causes pharynx collapse
- Reduced or no slow-wave sleep and less time in REM sleep
Diagnosis of Sleep Apnea
- Medical consensus and debate regarding apneic events and variability of patients' physiologies
- Use of multi-criteria decision rule to account for variability in defining events
- Polysomnography as the gold standard for diagnosis
- Oximetry as a simpler alternative for home testing
- Variability and limitations of equipment and methods
Frequency, Statistics, and Risk Factors of Sleep Apnea
- Sleep apnea affects approximately 1 in every 10 people globally
- Higher prevalence in men than women (2:1 ratio)
- Aging and obesity increase the risk
- Lack of awareness and underutilization of CPAP machines in developed and developing countries
- Association between sleep apnea and increased risk of various medical conditions, including Alzheimer's disease.
- Obstructive Sleep Apnea (OSA) accounts for 84% of cases
- Central Sleep Apnea (CSA) accounts for 0.9% of cases
- Mixed sleep apnea accounts for 15% of cases
- OSA is the most common category of sleep-disordered breathing
- CSA is characterized by a lack of respiratory effort during sleep
- Low muscle tone and soft tissue around the airway increase the risk of OSA
- Structural features that narrow the airway also contribute to the risk
- Obesity is a significant risk factor for developing OSA
- The risk of OSA increases with age, especially in the elderly
- Men are more likely to develop sleep apnea than women and children
- Common symptoms include loud snoring, restless sleep, and daytime sleepiness
- Diagnostic tests include home oximetry and polysomnography
- Hypoxemia (low blood oxygen) and sleep deprivation are complications of severe OSA
- Snoring, in combination with other risk factors, is highly predictive of OSA
- Up to 78% of genes associated with habitual snoring also increase the risk for OSA
Treatment Options for Sleep Apnea
- Lifestyle changes such as avoiding alcohol and losing weight can help manage OSA
- Sleeping at an elevated position or on the side can prevent airway collapse
- Oral appliances like the Mandibular advancement splint can keep the airway open
- Continuous positive airway pressure (CPAP) is the most effective treatment for severe OSA
- Surgical procedures may be recommended to remove or tighten tissue and widen the airway
Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times a night. In the most common form, this follows loud snoring. A choking or snorting sound may occur as breathing resumes. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. In children, it may cause hyperactivity or problems in school.
Sleep breathing disorder | |
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Other names | Sleep apnoea, sleep apnea syndrome |
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Obstructive sleep apnea | |
Pronunciation | |
Specialty | Otorhinolaryngology, sleep medicine |
Symptoms | Pauses breathing or periods of shallow breathing during sleep, snoring, tired during the day |
Complications | Heart attack, Cardiac arrest, stroke, diabetes, heart failure, irregular heartbeat, obesity, motor vehicle collisions, Alzheimer's disease, and premature death |
Usual onset | Varies; 50% of women age 20–70 |
Types | Obstructive sleep apnea (OSA), central sleep apnea (CSA), mixed sleep apnea |
Risk factors | Overweight, family history, allergies, enlarged tonsils, asthma |
Diagnostic method | Overnight sleep study |
Treatment | Lifestyle changes, mouthpieces, breathing devices, surgery |
Frequency | ~ 1 in every 10 people, 2:1 ratio of men to women, aging and obesity higher risk |
Sleep apnea may be either obstructive sleep apnea (OSA), in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA), in which regular unconscious breath simply stops, or a combination of the two. OSA is the most common form. OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain). It is often a chronic condition. Other risk factors include being overweight, a family history of the condition, allergies, and enlarged tonsils. Some people with sleep apnea are unaware they have the condition. In many cases it is first observed by a family member. Sleep apnea is often diagnosed with an overnight sleep study. For a diagnosis of sleep apnea, more than five episodes per hour must occur.
In CSA, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation can drop to a lower than normal level (hypoxaemia) and the concentration of carbon dioxide can build to a higher than normal level (hypercapnia). In turn, these conditions of hypoxia and hypercapnia will trigger additional effects on the body (such as Cheyne-Stokes Respiration). Brain cells need constant oxygen to live, and if the level of blood oxygen goes low enough for long enough, brain damage and even death can occur. A systemic disorder, sleep apnea is associated with a wide array of effects, including increased risk of car accidents, hypertension, cardiovascular disease, myocardial infarction, stroke, atrial fibrillation, insulin resistance, higher incidence of cancer, and neurodegeneration. The exact effects of the condition depend on how severe the apnea is and on the individual characteristics of the person having the apnea.
Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery. Effective lifestyle changes may include avoiding alcohol, losing weight, stopping smoking, and sleeping on one's side. Breathing devices include the use of a CPAP machine. With proper use, CPAP improves outcomes. Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness. Long term compliance, however, is an issue with more than half of people not appropriately using the device. In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP. Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.
Alzheimer's disease and severe obstructive sleep apnea are connected because there is an increase in the protein beta-amyloid as well as white-matter damage. These are the main indicators of Alzheimer's, which in this case comes from the lack of proper rest or poorer sleep efficiency resulting in neurodegeneration. Having sleep apnea in mid-life brings a higher likelihood of developing Alzheimer's in older age, and if one has Alzheimer's then one is also more likely to have sleep apnea. This is demonstrated by cases of sleep apnea even being misdiagnosed as dementia. With the use of treatment through CPAP, there is a reversible risk factor in terms of the amyloid proteins. This usually restores brain structure and diminishes cognitive impairment.
OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30–69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly. Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity.
sleep apnea (countable and uncountable, plural sleep apneas)